Surgery News- July 2008

6 TRAUMA SURGERY NEWS • J U LY 2 0 0 8 Gingival Suturing Secures Endotracheal Tube A 2-0 silk suture swaged on a cutting needle is inserted from the palatal side between two upper incisors to include 5-6 mm of gingival tissue margin. B Y P AT R I C E W E N D L I N G Else vier Global Medical Ne ws COURTESY DR. TED T. HUANG C H I C A G O — Suturing the stem of an airway tube to the gingival tissue is a novel and viable method to anchor an endotracheal tube or laryngeal mask airway, Dr. Ted T. Huang said at the annual meeting of the American Burn Association. Dislodgement is uncommon, and the su- tures do not mask or distort the facial features, contrary to what happens when a tube or mask is taped against the cheek, said Dr. Huang of the division of plastic surgery at the University of Texas Medical Branch, Galveston. Furthermore, loosened tape can lead to wound contamination, as well as extubation or dislodgement requiring reinsertion of the airway tube. The gingival suturing technique was used in 978 of 1,769 children undergoing reconstructive procedures under general anesthesia at the University of Texas between 2001 and 2004. Of these, 931 were head and neck procedures. Resuturing of the tube was needed in eight of the 978 patients (less than 1%) because the anchoring suture had cut through the gingival tissue, Dr. Huang reported on behalf of lead investigator Mark D. Talon, an anesthetist at the university. No sequelae or complaints of pain resulted from this problem, nor were any dental injuries or airway loss observed. With this technique, an endotracheal tube or laryngeal mask airway is inserted and then the airway tube is positioned to one side of the midline between both incisors. Using a 2.0 silk suture swaged on a cutting needle, the surgeon places a suture in the gingiva of the upper incisor interdental space. This is achieved by passing a curved needle from the palatal side through the mucosa to the buccal side. Suturing must include 4-5 mm of mucosal tissue to avoid transecting the mucosa with the tying of the suture, Dr. Huang said. Two loops are placed around the laryngeal mask airway or endotracheal tube and secured with a surgical knot. The tube is tied against the incisor teeth for stability. The technique can be used in young children with no teeth by placing the sutures above the teeth buds. “This technique is very simple and effective, and it doesn’t encroach on the surgical site,” Dr. Huang said. Silk sutures are better than chromic sutures or wire, which can cause dental and gingival trauma, according to Dr. Huang. Gingival sutures used for chronic anchoring should be checked regularly for erosion that might cause unexpected extubation, he cautioned. Several audience members said they have had success with the technique, including Dr. Debra A. Reilly, who said she uses gingival anchoring for all pediatric and adult patients with facial burn wounds. Dr. Reilly, director of the burn center at the University of Nebraska, Omaha, said she also prefers silk sutures because it is hard for nursing staff to see chromic sutures post operatively and because wire can be difficult to manage in an emergency. Dr. Steven E. Wolf, who commented on the study, questioned the utility of gingival anchoring, calling it “a bit of overkill.” Procedures on the head and neck “are routinely done without such an invasive maneuver, and it is only a matter of time until a complication occurs,” said Dr. Wolf, an ACS Fellow and professor of surgery at the University of Texas, San Antonio. ■ http://www.facs.org/cancerprograms/mh08 http://www.facs.org/cancerprograms/mh08

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Surgery News- July 2008 Contents The 20/20 Vision: Health Reform Trauma: Airway Anchor News From the College: Jacobson Winner General Surgery: Worth the Trouble

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